Subject(s)
Aneurysm, False/diagnosis , Aneurysm, False/surgery , Fibrosis/surgery , Heart Aneurysm/diagnosis , Heart Aneurysm/surgery , Thoracic Surgery/methods , Aneurysm, False/diagnostic imaging , Aortic Valve/diagnostic imaging , Echocardiography, Transesophageal , Fibrosis/complications , Heart Aneurysm/diagnostic imaging , Humans , Mitral Valve/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: In left atrial appendage (LAA) closure, the correct sizing of the implantable devices is crucial. Data on the time-dependent changes in the shape and positioning of LAA occlusion devices are missing. We analyzed the results of 33 consecutive patients after implantation of an Amplatzer™ Cardiac Plug (ACP) LAA closure device to get more information on the optimal device sizing during implantation. METHODS AND RESULTS: Thirty-three consecutive patients were enrolled in this observational study. ACP implantation was guided by fluoroscopy and three dimensional transesophageal echocardiography (3-D TEE). Device sizing was based on the largest measured diameter of the intended landing zone adding 2-4 mm of device oversizing. Fluoroscopies were performed at 1 day after, and after 3 months, control 3-D TEE was performed 3 months after implantation. The stability of device positioning and shape was matched with the results of 3-D TEE. Patients' mean age was 70.2 ± 8 years; mean CHA2DS2VASc score was 3.8 ± 1.1. According to the manufacture's classification, the post-implant degree of compression of the device-lobe was classified in three categories 1) undercompression "square-like shape" (1 patient); 2) optimal compression "tire-like shape" (20 patients), 3) overcompression "strawberry-like shape" (12 patients). Changes in the degree of device compression by more than one classification class occurred in 18/33 of our patients. A complete loss of device compression ("square-like shape") was observed in 9 patients. Despite the changes in device compression, a complete closure of the LAA was achieved in 32/33 patients. CONCLUSIONS: There is a temporal change in shape and positioning of the ACP within 3 months after implantation. A late decompression of the ACP lobe was observed in 61% of our patients, leading to a complete loss in device compression in 27%. This observation may be the rationale for a higher degree of ACP oversizing during implantation.
Subject(s)
Atrial Appendage , Cardiac Catheterization/instrumentation , Septal Occluder Device , Aged , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Cardiac Catheterization/adverse effects , Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Female , Fluoroscopy , Follow-Up Studies , Humans , Male , Middle Aged , Pressure , Prospective Studies , Prosthesis Design , Stroke/etiology , Stroke/prevention & control , Time Factors , Treatment OutcomeABSTRACT
Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.
Subject(s)
Cesarean Section/methods , Embolectomy/methods , Pregnancy Complications, Cardiovascular , Pulmonary Embolism , Adult , Echocardiography, Transesophageal/methods , Emergency Treatment/methods , Female , Gestational Age , Humans , Infant, Newborn , Intraoperative Care/methods , Male , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Cardiovascular/surgery , Pulmonary Artery/surgery , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Pulmonary Embolism/surgery , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Treatment OutcomeSubject(s)
Cutis Laxa/complications , Heart Diseases/etiology , Sweet Syndrome/complications , Female , HumansSubject(s)
Cardiac Catheterization , Dyspnea/therapy , Embolism, Paradoxical/therapy , Foramen Ovale, Patent/therapy , Hypoxia/therapy , Stroke/therapy , Anticoagulants/therapeutic use , Cardiac Catheterization/instrumentation , Dyspnea/etiology , Dyspnea/physiopathology , Embolism, Paradoxical/etiology , Foramen Ovale, Patent/complications , Humans , Hypoxia/etiology , Hypoxia/physiopathology , Patient Selection , Platelet Aggregation Inhibitors/therapeutic use , Posture , Septal Occluder Device , Stroke/etiology , Syndrome , Treatment OutcomeSubject(s)
Aneurysm/complications , Diverticulum/complications , Subclavian Artery/abnormalities , Aneurysm/diagnostic imaging , Aneurysm/surgery , Diverticulum/diagnostic imaging , Diverticulum/surgery , Humans , Predictive Value of Tests , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Terminology as Topic , Tomography, X-Ray Computed , Unnecessary ProceduresSubject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Coronary Occlusion/therapy , Acute Disease , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Collateral Circulation , Coronary Artery Bypass/adverse effects , Coronary Circulation , Coronary Occlusion/diagnosis , Coronary Occlusion/physiopathology , Drug-Eluting Stents , Humans , Intra-Aortic Balloon Pumping , Patient Selection , Risk Assessment , Treatment OutcomeABSTRACT
Arteria lusoria, an aberrant or anomalous right subclavian artery, is the most common anomaly of the aortic arch. It may be associated with other congenital anomalies of the heart and great vessels-including, rarely, truncus bicaroticus (a common trunk of both common carotid arteries), and, even more rarely, aneurysmal formation.Herein, we report the case of a 72-year-old man who had both an atherosclerotic aneurysm of an aberrant right subclavian artery and truncus bicaroticus. We resected the aneurysm through a posterolateral thoracotomy and did not restore the distal pulsatile blood supply to the right arm. During long-term clinical follow-up, the patient experienced no arm ischemia or cerebrovascular insufficiency.Aneurysm of arteria lusoria should be suspected in the presence of a right superior mediastinal mass on chest radiographs and should be considered as a cause of new-onset dyspnea, chest pain, or dysphagia. Symptomatic right arteria lusoria aneurysm should be removed promptly after diagnosis. Despite disagreement among investigators regarding the need to restore pulsatile blood flow to the right arm, we recommend reconstructing that flow, when possible.